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Preventing recurrent events long term after coronary artery bypass graft: suboptimal use of medications in a
Pamela J Bradshaw1, Konrad Jamrozik, Ian Gilfillan
1School of Population Health, University of Western Australia, Perth, Australia. pamela.bradshaw@health.wa.gov.au
Insights
Long-term medication use after coronary artery bypass graft (CABG) shows gaps, with older patients and smokers less likely to use crucial cardiac event prevention drugs like antiplatelets and statins.
Area of Science:
- Cardiology
- Public Health
- Pharmacotherapy
Background:
- Limited population-based data exist on long-term management post-coronary artery bypass graft (CABG).
- Patients undergoing CABG face a high risk of future major vascular events.
- Understanding pharmacotherapy use is crucial for secondary prevention in this population.
Purpose of the Study:
- To assess the prevalence of pharmacotherapy for preventing new cardiac events in long-term survivors of CABG.
- To identify factors associated with the use of key medications after CABG.
Main Methods:
- A postal survey was administered to 2500 randomly selected patients 6 to 20 years post-CABG.
- Data collected included medication use, patient demographics, and clinical factors.
- Statistical analysis identified correlates of medication adherence.
Main Results:
- Antiplatelet (80%) and statin (64%) use decreased with increasing age.
- Current smokers were less likely to use aspirin (OR 0.59).
- Angiotensin-converting enzyme inhibitors were common for hypertension (59%), with use higher in patients with diabetes or heart failure symptoms.
Conclusions:
- Significant gaps exist in the use of recommended medications following CABG.
- Older age, lack of angina, comorbid heart failure/hypertension, and infrequent cardiologist visits were linked to lower antiplatelet and statin use.
- Smoking may be associated with reduced medication adherence post-CABG.
Background:
There are few population-based data on long-term management of patients after coronary artery bypass graft (CABG), despite the high risk for future major vascular events among this group. We assessed the prevalence and correlates of pharmacotherapy for prevention of new cardiac events in a large population-based series.
Methods:
A postal survey was conducted of 2500 randomly selected survivors from a state population of patients 6 to 20 years after first CABG.
Results:
Response was 82% (n = 2061). Use of antiplatelet agents (80%) and statins (64%) declined as age increased. Other independent predictors of antiplatelet use included statin use (odds ratio [OR] 1.6, 95% CI 1.26-2.05) and recurrent angina (OR 1.6, CI 1.17-2.06). Current smokers were less likely to use aspirin (OR 0.59, CI 0.4-0.89). Statin use was associated with reported high cholesterol (OR 24.4, CI 8.4-32.4), management by a cardiologist (OR 2.3, CI 1.8-3.0), and the use of calcium channel-blockers. Patients reporting hypertension or heart failure, in addition to high cholesterol, were less likely to use statins. Angiotensin-converting enzyme inhibitors were the most commonly prescribed agents for management of hypertension (59%) and were more frequently used among patients with diabetes and those with symptoms of heart failure. Overall 42% of patients were on angiotensin-converting enzyme inhibitors and 36% on beta-blockers.
Conclusions:
Gaps exist in the use of recommended medications after CABG. Lower anti-platelet and statin use was associated with older age, freedom from angina, comorbid heart failure or hypertension, and not regularly visiting a cardiologist. Patients who continue to smoke might be less likely to adhere to prescribed medications.
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